Morphological Patterns Research Articles

Prognostic factors for intravitreal conbercept in the treatment of choroidal neovascularization secondary to pathological myopia.

To identify risk factors influencing visual outcomes in patients with pathological myopia-associated choroidal neovascularization (PM-CNV) following intravitreal injections of conbercept. A total of 86 eyes from 86 patients received intravitreal conbercept in a 1 + PRN regimen. After the initial injection, patients were followed for 12months. They were categorized into two groups based on their 12-month visual acuity change: those who achieved greater than a one-line improvement in BCVA (improved group; n = 65) and those who experienced a one-line or lesser improvement or a decrease in BCVA (non-improved group; n = 21). Over the 12-month period, the mean BCVA in the improved group significantly improved from 0.82 to 0.41 LogMAR. In the non-improved group, BCVA changed from 1.24 to 1.09 LogMAR. Similarly, the mean CRT decreased from 426.21μm at baseline to 251.56μm at 12months in the improved group, and from 452.47 to 382.45μm in the non-improved group. Multivariable logistic regression analyses revealed that older age (OR 1.287; 95% CI 1.019-1.625; P = 0.034), poorer baseline BCVA (OR 6.422; 95% CI 1.625-25.384; P = 0.008), the presence of subfoveal CNV (OR 4.817; 95% CI 1.242-18.681; P = 0.023), and organized interlacing patterns of CNV morphology (OR 5.593; 95% CI 1.397-22.392; P = 0.015) emerged as independent risk factors correlated with worsened visual prognosis following intravitreal conbercept injections. Conbercept demonstrates significant efficacy and safety in treating PM-CNV. Key factors influencing visual recovery post-treatment include older age, poorer baseline BCVA, the presence of subfoveal CNV, and organized interlacing patterns of CNV morphology.

Differentiating malignant from benign splenic lesions: a meta-analysis and pictorial review of imaging features.

Splenic lesions might exhibit overlapping imaging features, varying from benign entities like cysts and hemangiomas to malignancies such as lymphoma and angiosarcoma. This meta-analysis aims to delineate imaging characteristics that distinguish malignant from benign splenic lesions. Adhering to PRISMA guidelines, we searched PubMed, Scopus, and Web of Science for studies on imaging features differentiating malignant from benign splenic lesions. We extracted data on splenic pathology and imaging characteristics and assessed the methodological quality via QUADAS-2. Odds ratio meta-analyses were performed using STATA (Version 17.0, Stata Corp, College Station, TX). Portal phase hypoenhancement, hypovascular enhancement pattern, diffusion restriction, and late phase hypoenhancement, with odds ratios above 10, highly indicate malignancy. Other features suggestive of malignancy include solid morphology, lymphadenopathy, presence of perisplenic fluid, arterial hypoenhancement, hypoechogenicity on ultrasound, splenomegaly, and presence of multiple lesions. In contrast, cystic morphology, hypervascular-washout and hypervascular-persistent pattern of enhancement, late phase hyperenhancement, anechogenicity on ultrasound, portal phase hyperenhancement, well-defined borders, and calcification are in favour of benign pathology. The study underscores the critical role of contrast-enhanced and diffusion-weighted imaging in distinguishing malignant from benign splenic lesions, emphasizing the role of features like portal phase hypoenhancement and restricted diffusion in diagnosing malignancies. Additionally, the study emphasizes the value of contrast-enhanced ultrasound, which allows for the visualization of key contrast-enhancement patterns without the risk of ionizing radiation exposure.

Disodium Cromoglycate Templates Anisotropic Short-Chain PEG Hydrogels.

Anisotropic hydrogels have found widespread applications in biomedical engineering, particularly as scaffolds for tissue engineering. However, it remains a challenge to produce them using conventional fabrication methods, without specialized synthesis or equipment, such as 3D printing and unidirectional stretching. In this study, we explore the self-assembly behaviors of polyethylene glycol diacrylate (PEGDA), using disodium cromoglycate (DSCG), a lyotropic chromonic liquid crystal, as a removable template. The affinity between short-chain PEGDA (Mn = 250) and DSCG allows polymerization to take place at the DSCG surface, thereby forming anisotropic hydrogel networks with fibrin-like morphologies. This process requires considerable finesse as the phase behaviors of DSCG depend on a multitude of factors, including the weight percentage of PEGDA and DSCG, the chain length of PEGDA, and the concentration of ionic species. The key to modulating the microstructures of the all-PEG hydrogel networks is through precise control of the DSCG concentration, resulting in anisotropic mechanical properties. Using these anisotropic hydrogel networks, we demonstrate that human dermal fibroblasts are particularly sensitive to the alignment order. We find that cells exhibit a density-dependent activation pattern of a Yes-associated protein, a mechanotransducer, corroborating its role in enabling cells to translate external mechanical and morphological patterns to specific behaviors. The flexibility of modulating microstructure, along with PEG hydrogels' biocompatibility and biodegradability, underscores their potential use for tissue engineering to create functional structures with physiological morphologies.

Patterns of Geriatric Anemia – A Clinicopathological Study

Background : Anemia is a common condition in elderly especially in hospitalized geriatric patients and is known to be associated with increased morbidity and mortality. The UN agreed cut off to refer to the older population is 60years and above. Anemia in the elderly is defined as a haemoglobin concentration below12 gm/dl in women and below 13gm/dl in men. Objectives: To study the grade and patterns of anemia in Geriatric age group of both sex with clinicopathological correlation. Materials and Methods: It is a Prospective study of 2 years from May 2018 to April 2020 carried out in KIMS, Hubbali. A statistically significant sample size was 400. Results: Among the total geriatric cases of 400, males were 233 (58.25%) and females were 167 (41.75%). In which majority of them were in the age group between 60-69 years that is 237 (59.25%) cases, followed by 121 (30.25%) cases, 38 (9.5%) cases and 4 (1%) cases were in the age group between 70-79 years, 80-89 and above 90 years respectively. The study showed that majority of the cases belonged to the Grade 1 anemia (69.25%). On smear examination most common morphological pattern was Normocytic Normochromic Anemia (75%), followed by Microcytic Hypochromic Anemia (18%). On clinical history correlation, majority of them were asymptomatic 52% and 38% of cases presented with fatigue. Conclusion: The study concludes that diagnosing different morphological patterns of geriatric anemia and its clinical correlation helps in reducing the morbidity and mortality of geriatrics related to anemia and also facilitate the clinicians to improve the treatment protocols and prophylactic therapy. Keywords Geriatrics, Patterns, Anemia

Facial morphological analysis for the development of a representative atlas of the brazilian population

The objective of this study was to propose categories of morphological classification for the face and its anatomical structures, as well as to propose illustrations to support the development of an atlas that facilitates facial morphological analysis of adult Brazilians. It was a descriptive study based on the analysis of the frequency and distribution of 13 photoanthropometric facial ratios (RFAs) obtained from a representative sample of the Brazilian population. RFAs related to facial height and width, eye width, intercanthal distance, nose length and width, philtrum ridge height and width, mouth thickness and width, upper and lower lip thickness, and chin height were analyzed. The study included a sample of 5.000 individuals aged between 18 and 22 years, evenly distributed between genders. Data normality was assessed using the Shapiro-Wilk test, considering them as parametric when p > 0.05. For the RFAs that showed normal distribution, mean ± 1.5 standard deviations (SD) were used to categorize facial measurements as regular, below average, or above average. Non-parametric RFAs were analyzed based on the median and 10th and 90th percentiles of the data. Based on the established average iris diameter, which is considered the most stable facial measurement, the values of the described RFAs were converted to a numerical scale in centimeters, allowing for the illustration of female and male faces. In this way, it was possible to categorize the facial anatomical structures and, consequently, visualize the facial morphological pattern of the adult Brazilian population.

Morphological patterns and distribution of Inselbergs in Quixadá and Quixeramobim – Northeastern Brazil

Morphological patterns and distribution of Inselbergs in Quixadá and Quixeramobim – Northeastern Brazil

A secondary endochondral ossification centre in the furcula of extant birds and its significance for the evolution of the neornithine acrocoracoclavicular joint

ABSTRACT The processus acrocoracoideus claviculae on the furcular epicleidium of some extant birds has been hypothesised to have developed independently from the main body of furcula, potentially representing a secondary ossification centre within avian furcula. However, the developmental pattern of the processus acrocoracoideus claviculae remains unclear, impeding our understanding of its homology and evolution. Here, we analysed the morphology, articulation and developmental pattern of the avian furcular epicleidium through X-ray computed tomography scanning and histochemical staining in several bird exemplars. The results show that the processus acrocoracoideus claviculae is a secondary endochondral ossification in the furcula, distinct from the intramembranously ossified main furcula and separated by connective tissue. The processus acrocoracoideus claviculae fuses with the furcula during postnatal development and forms the articular surface of the acrocoracoclavicular joint. The developmental pattern suggests that the left and right processus acrocoracoideus claviculae may be formed by the fusion of a sesamoid with the respective furcular ramus and evolved convergently among different neornithine lineages. This unique structure of furcula not only increases the morphological diversity of the acrocoracoclavicular joint in neornithine birds but also lays the foundation for their complex and diverse flight styles.

One-pot synthesis of Li3xLa2/3−xTiO3/PVA composite with high tunable electrical attributes governed by the Li+ content

The primary goal of this study is to elucidate the structural and electrical characteristics, alongside potential applications, of ceramic-polymeric composites. These composites are achieved by incorporating lithium-lanthanum titanates (Li3xLa2/3−xTiO3 - LLTO) into a polyvinyl alcohol polymeric matrix (PVA). The synthesis of lithium-lanthanum titanates occurred through high-energy ball milling method. Then, three types of composites were produced using the solvent casting method: a sample of pure Poly (vinyl alcohol) polymer (PVA), a second PVA composite with the addition of La0·59Li0·24TiO3 (Li-0.24) and a third sample with La0·56Li0·33TiO3 (Li-0.33). SEM and AFM analyzes revealed notable changes in the morphology and 3D spatial patterns of the films upon incorporating lithium-lanthanum titanates into the PVA matrix. The PVA film presents a topography featuring a more evenly distributed range of topographic heights, indicating a smoother surface structure. With varying LLTO content, the morphology of the PVA composite underwent changes. The lower roughness of the PVA surface is evident from its measured average roughness value (Ra = 1.9 ± 0.5 nm). Upon incorporating LLTO, the surfaces displayed increased roughness, measuring specifically at 40.1 ± 7.3 nm (Li-0.24) and 22.7 ± 5.5 nm (Li-0.33). Notably, there was an approximately 43 % reduction in the average roughness value from Li-0.24 to Li-0.33. The analysis by Raman allowed the identification of functional groups of the PVA polymeric chain, in addition to the presence of some vibrational modes related to the structure of lithium-lanthanum titanates for the sample with the highest content of Li+ ions (Li-0.33). Finally, the sample Li-0.33 showed the lowest value of electrical resistance (67 kΩ) and of phase angle (16°), compared to the PVA (100 MΩ and 90°). These results show that the presence of the LLTO changed the insulating behavior of the PVA matrix changed and improved potential to electronic applications.

Comparative SEM Study of Sensilla and Tyloid Structures in the Antennae of Vespinae (Hymenoptera: Vespidae).

This study investigates the distribution, morphology, and potential functions of antennal sensilla in various wasp species, including Dolichovespula flora, D. intermedia, Vespula structor, Vl. vulgaris, Provespa barthelemyi, Vespa bicolor, V. ducalis, V. mocsaryana, and V. velutina var. nigothorax. The study thoroughly analyzes the antennal structure of these species, representing all four genera of the yellow-jacket and hornet subfamily Vespinae. Using scanning electron microscopy (SEM), the study identifies a total of nineteen types of sensilla, including sensilla trichodea (ST-I, ST-II, ST-III), sensilla campaniform (SCF-I, SCF-II, SCF-III), pit organs (SCO-I, SCO-II, and SA), sensilla placodea (SP-I, SP-II), sensilla chaetica (SCH-I, SCH-II), sensilla basiconica (SB-I, SB-II), sensilla agmon (SAG-I, SAG-II), and sensilla coelocapitular (SCA). Additionally, tyloids were observed in the males of seven species, except for Vl. structor and Vl. vulgaris. The study provides insights into these sensilla types' morphology, abundance, and distribution. It discusses the variations in sensilla morphology among different species and the presence of gender-specific sensilla. This study provides new data about the morphology and distribution patterns of sensilla and tyloid.

Steatohepatitic hepatocellular Carcinoma:A new approach to classifying morphological subtypes of hepatocellular carcinoma

Histological subtyping of hepatocellular carcinoma (HCC) is challenging in the presence of histological heterogeneity, where distinctly different morphological patterns are present within the same tumor. Current approaches rely on percent cut-offs. We hypothesized that morphologic intratumor heterogeneity is a non-random biological feature and that incorporating recurrent patterns would improve histological subtyping of HCC. Resected HCC were studied and the overall frequency of morphologic intratumor heterogeneity was 45% in 242 specimens. Steatohepatitic HCC (SH-HCC) had the highest frequency of morphologic intratumor heterogeneity (91%); this was confirmed in additional cohorts of SH-HCC from different medical centers (overall frequency of 78% in SH-HCC). Morphologic intratumor heterogeneity in SH-HCC showed distinct and recurrent patterns that could be classified as early, intermediate, and advanced. Incorporating these patterns into the definition of SH-HCC allowed successful resolution of several persistent challenges: the problem of the best cut-off for subtyping SH-HCC, the problem of the relationship between SH-HCC and scirrhous HCC, and the classification for HCC with abundant microvesicular steatosis. This approach also clarified the relationship between SH-HCC and CTNNB1 mutations, showing that CTNNB1 mutations occur late in a subset of SH-HCC. In summary, there is a high frequency of morphologic intratumor heterogeneity in HCC. Incorporating this finding into histological subtyping resolved several persistent problems with the SH-HCC subtype.

Assessing structure, spatial patterning, and size class distribution of miombo woodland species along a precipitation gradient

Our study investigates the intricate ecological mechanisms shaping miombo woodlands across a rainfall gradient in Zimbabwe. We comprehensively analysed vegetation structure, tree morphology, and spatial patterning across three distinct ecological regions characterized by varying mean annual precipitation (MAP). Results reveal that taller and larger trees are prevalent in the more humid site, while higher tree density is observed in the drier site. The spatial analysis highlights a significant aggregation of adult miombo species across all sites, with juveniles exhibiting a propensity to cluster around adult trees. These findings underscore the pivotal role of ecological gradients, such as precipitation, in shaping miombo woodland structure. However, the absence of clear spatial patterns across the rainfall gradient suggests that precipitation may have less influence on the spatial distribution of miombo trees. Understanding these complex ecological dynamics is essential for developing targeted conservation and management strategies that align with the unique attributes of miombo woodlands, critical ecosystems within the African landscape particularly vulnerable to global climate change.

Revealing the urban heat exposure risk network: Exploring the possibility of mitigate heat-related risks form a network perspective

The exposure of urban residents to heat waves is expected to increase in the future. However, the analyses regarding the spread characteristics and trends of heat exposure risk in different cities are lacking. In this study, we proposed a framework to identify the network spread characteristics of heat exposure risk based on morphological spatial pattern analysis and applied it to 33 provincial capital cities in China. We explored the patterns and characteristics of heat exposure risk diffusion at different urbanization stages and for different urban sizes and in response to socioeconomic factors. The results show that network spread is common in all cities. From 2000 to 2020, heat exposure risk exhibited a strengthening diffusion trend, and line to Surface accounted for the highest proportion and area. There are great differences in the degree of heat exposure risk expansion in different cities. Urban size determines the speed of expansion in heat exposure risk, and the proportion of risk areas indicates that some medium-sized cities, such as Haikou and Lanzhou warrant greater research attention. Socioeconomic factors, notably GDP, positively influence risk expansion, but their impact weakens over time and with urban size growth. The present research results provide evidence for the spread characteristics of heat exposure risk, and provide a new perspective for mitigating the heat-related risk.

Establishment and optimization of urban ecological network based on ecological regulation services aiming at stability and connectivity

Establishing an urban ecological network is a means to improve the ecological environment and enhance sustainable urban development amidst rapid urbanization. Based on the demand of eco-city, morphological spatial pattern analysis (MSPA), ecological regulation services value (ERSV), and landscape connectivity have been combined to identify ecological resources with high connectivity and ecological benefits in this study. Using the Minimum Cumulative Resistance (MCR) model, ecological corridors have been constructed and ecological critical nodes have been identified. In addition, the urban ecological network has then been optimized from the overall layout and local key nodes based on the circuit theory to balance the ecological livability and species diversity in the eco-city. The main conclusions could be demonstrated as follows: (1) 76.45% of the high ecological regulation service value areas have been identified as core areas. (2) The distribution of ecological corridors has been found uneven with significant disparities (3) The connectivity indices, especially the line point rate (β) index, have increased by 21.66%, while the robustness has increased by 75.44%. Overall, the combined methods have been used to establish and optimize the ecological network within the limited space to balance the ecological livability and biodiversity. The results of this study could provide a scientific reference for the optimization of urban ecological space and promote sustainable development in the eco-city.

Earthquake Seismicity Reveals the Location and Significance of the Shona Mantle Plume in the South Atlantic Ocean

AbstractThe South Atlantic Ocean hosts several well‐studied volcanic ridges and seamount chains, but the origin of their associated mantle plumes is debated. Reduced seismicity on the southern Mid‐Atlantic Ridge (MAR) suggests anomalously ductile thermomechanical conditions at 52°S and 47.5°S. These low seismicity patches extend 120–560 km along‐axis, and correspond with axial high spreading ridge morphology, geochemical anomalies, and mantle wave speed patterns likely associated with the Shona and Discovery plumes. Bathymetric data show that the northern extent of the Shona swell is associated with increased volcanism, elevated axial bathymetry, and a series of northward‐propagating rifts, with the overall swell geometry suggesting a buoyancy flux of 0.4–0.5 Mg s−1. The nearby Bouvet Island may be a product of a branch of the larger Shona plume swell, which has influenced crustal accretion on the southern MAR for the past 24 million years.

Standardizing the optimal photo-diode performance of CuO nanostructures through various morphological patterns

The CuO nanocrystals were prepared using a simple surfactant-assisted co-precipitation technique then addition of anionic surfactants such as Hexamine (HEX), Polyvinyl Pyrrolidone (PVP), Polyvinyl Alcohol (PVA) and Cetyl Trimethyl Ammonium Bromide (CTAB) leads to the formation of CuO nanostructures on the surface of spherical particles. Samples were characterized via X-ray Diffraction (XRD), Fourier Transform Infrared Spectroscopy (FT-IR), Field Emission Scanning Electron Microscopy (FESEM), UV–visible diffuse reflectance spectroscopy and I-V characteristics. According to various spectroscopic results, all surfactant decorated CuO nanocrystal have a monoclinic crystal structure. Then the average grain size of CuO samples supported by HEX, PVA, PVP and CTAB is approximately 72 nm. The properties of surfactants have been shown to affect size and shape. In addition, the FT-IR spectra of all samples show three similar vibration modes of CuO, this indicates the presence of a monoclinic CuO crystal structure. According to absorbance data, the quantum confinement effect caused by the use of surfactant significantly affects the optical bandgap value, ranging from 3.00 to 2.59 eV. Current-voltage characteristics [I-V] unveil the photodiode parameters of prepared diode are evaluated in the dark and light condition. In this case, the barrier height (ΦB) is 0.80 eV and the ideal value for the diode (n) is 2.05, which is more suitable for photodiode applications.

Evaluation of Morphological Variants of Soft Palate in Individuals with Different Skeletal Patterns Using Digital Lateral Cephalometric Images

Background and Objectives The soft palate has morphological variations in lateral cephalometric images. Several studies are available on the analysis of the dimensions of the soft palate, but few have investigated the morphology of the soft palate. The aim of this study is to investigate the relationship between morphological variations of the soft palate and types of malocclusion in Ahvaz, southwest of Iran. Subjects and Methods In this descriptive-analytical study, the lateral cephalometric images of 162 patients with abnormal skeletal pattern available in the archive of the Radiology Department of Jundishapur School of Dentistry in Ahvaz were used. The radiographs were divided into 6 groups (leaf shape, rat tail shape, butt like, straight line, distorted soft palate, and crook shape) under the supervision of a radiologist. The data were analyzed to determine the relationship between soft palate morphology and skeletal pattern . Results The results showed that 51.2% of the patients’ skeletal pattern were class two, 37% were class one, and 11.8% were class three . The most prevalent soft palate morphology observed in this study was the "rat tail" shape, accounting for 61.7% of all participants. This morphology was consistently the most common across all investigated skeletal classifications. The "leaf" shape followed in prevalence, representing 18.5% of the sample. The least frequent morphology, identified in only 2.5% of participants, was the "S-shaped" type. This pattern of prevalence held true within each individual skeletal pattern as well. Conclusion Rat tail shape of soft palate was by far the most common morphology while distorted soft palate or S-shaped soft palate was the rarest form of soft palate in patients. There is no relationship between the skeletal pattern of the jaw and the morphology of the soft palate in the studied population .

Effect of channel morphological changes on wetland transformation

Keeping aside the traditional approaches to investigating floodplain wetland transformation, the current study investigated various aspects of it through changes in river channel morphology and drainage pattern. The study analyzed wetland transformation using satellite image-based machine learning and intensive fieldwork. Ordinary Least Square (OLS) regression was applied to identify dominant influencing factors among 24 contributing factors under six clusters to eight dependent phenomena of transformation. The result showed that 57 % of wetland area lost since 1991, and existing wetland has also experiencing hydrological scarcity. From 1991 to 2021, the area under low water depth (<1 m.) inflated from 18.55 % to 50.54 %, the hydro-period narrowed down, and the appearance of water become inconsistent. The OLS result showed that changes in channel morphology (bottle neck channel, embankment-driven carrying capacity enhancement, etc.), interruptions in river and wetland connecting channels (source closure, breaching the continuity, conversion in to agricultural land, etc.), and changes in flood ambience (regulated by dam construction, erection of embankments, etc.) majorly contributed to wetland transformation. Very high explainability was found in the cases of rate of wetland loss, decreasing water depth under greater depth, narrowing hydro-period (R2 > 0.9). The findings of this work would be a good policy document for floodplain wetland management.

Comparative study on clinicopathological characteristics of functional and non-functional subtypes in pituitary adenomas

BackgroundPituitary adenomas comprise clinical and pathological characteristics of functional and non-functional subtypes. To enhance our understanding of diagnostic presentations, our study aimed to know the clinicopathological characteristics of pituitary adenomas of both functional and non-functional subtypes. The purpose of our study was to investigate the clinicopathological characteristics of pituitary adenomas, including demographic characteristics, clinical presentations, hormone secretion patterns, invasiveness, and cellular characteristics.MethodsA total of 41 cases of pituitary adenomas were analyzed, with 63.4% classified as non-functional adenomas (NFPA) and 36.6% as functional adenomas (FPA). Clinical presentations vary, with vision loss and headaches commonly occurring in both NFPA and FPA. In FPAs, serum hormone levels varied and were categorized into growth hormone-secreting (53.3%), ACTH-secreting (26.7%), PRL-secreting (13.3%), and FSH-secreting (6.7%) subtypes. Moreover, clinical presentations in FPA included diplopia, giddiness, vomiting, ptosis, and limb weakness. Clinical features varied across subtypes, with acromegaly in growth hormone-secreting adenomas, moon facies and weight gain in ACTH-secreting adenomas, poor facial growth in PRL-secreting adenomas, and vision loss in FSH-secreting adenomas. Meanwhile, NFPA were predominantly macroadenomas (88.5%) and exhibited various morphological patterns.ResultsThe proliferation index is higher in functional adenomas (mean 1.32) as compared to non-functional (mean 0.91). Clinical presentations varied across functional and non-functional adenomas. Growth hormone-secreting adenomas were the most common functional subtype, while LH and null cell adenomas were common non-functional subtypes. Two cases were invasive adenomas with a low Ki67 index. Sheets were the most common morphological pattern. PCA analysis revealed significant differences between the two groups, with PC 1 explaining 92.111% of the variance.ConclusionsOur study elucidates the clinicopathological characteristics of pituitary adenomas, highlighting significant differences between functional and non-functional subtypes. These findings underscore the importance of tailored diagnostic and management strategies to optimize outcomes for patients with pituitary adenomas.

Evaluation of chronic perilunate dislocations: A comparative study of single-stage, two-stage ORIF, and salvage procedures

ObjectiveThis study aims to evaluate the outcomes of open reduction and internal fixation (ORIF) for chronic perilunate dislocations using single-stage, two-stage, and salvage procedures. The study also compares these approaches with each other and with results from existing literature. MethodsA total of 15 patients with chronic perilunate injuries from 2013 to 2019 were included in the study. Pre-operative and post-operative assessments were conducted using plain radiographs, with CT scans performed selectively for detailed morphology and fracture pattern analysis. Among the patients, 13 underwent ORIF, while 2 underwent salvage procedures. Among the ORIF cases, single-stage procedures were performed in 4 patients, and two-stage procedures in 9 patients. External fixators, including unilateral uniplanar external fixators (UUEF) and bilateral uniplanar external fixators (BUEF), were applied in 5 and 4 patients, respectively. Our methodology of treating chronic perilunate injuries has evolved over the years. We started with single stage ORIF then graduated to a two staged procedure initially using a external fixator as a carpal distractor applied only on the radial side and finally settling down with bilateral carpal distraction using external fixators both on the radial and ulnar sides. ResultsAmong the 15 patients, 3 were lost to follow-up. Of these, one underwent four-corner fusion, while the remaining two had UUEF. The mean time interval between injury and surgery was 3.60 months. The post-operative mean scapholunate angle measured 52.46°, with a negative radio-lunate angle (indicating flexion) observed in two patients, while others showed a positive angle (indicating extension). Two cases exhibited nonunion and avascular necrosis (AVN) of the scaphoid, while one case presented with lunate AVN. Mid-carpal and radio-carpal arthritis was observed in 4 and 2 patients, respectively. Functional outcomes were evaluated using Mayo's wrist score categorized as good for two-stage BUEF cases and satisfactory for UUEF and single-stage procedures. ConclusionStaged reduction utilizing the BUEF followed by open reduction has demonstrated superior outcomes when compared to UUEF, single-stage open reduction and salvage procedures. Level of evidence: 4

Spatio-temporal analysis of LST, NDVI and SUHI in a coastal temperate city using local climate zone

Extreme heat due to changing climate poses a new challenge for temperate climates. The challenge is further aggravated by inadequate research, policy, or preparedness to effectively respond and recover from its impacts. While urban morphology is crucial in mitigating urban heat, it has received limited attention in urban planning, highlighting the need for further exploration, particularly in temperate regions. To illustrate the challenge and its potential mitigations, we use the example of the coastal temperate city of Cardiff. To establish the interrelations between urban morphology and urban heat island patterns, we explored the spatiotemporal variations in land surface temperature (LST), normalised difference vegetation index (NDVI), and surface urban heat island (SUHI) to local climate zone (LCZ) classification for Cardiff. Results showed a significant variation in SUHI in the LCZ zones. Both LST and NDVI land were found to vary significantly across the LCZ zones demonstrating their association with the urban form and morphology of the locality. For built-up areas, a more compact built-environment with smaller vegetation cover and larger building density was 2.0 °C warmer than the open built-environment when comparing the mean summer LSTs. On average, the natural classes exhibit a LST that is 8.0 °C lower than the compact built-environment and 6.0 °C lower than the open built-environment. Consequently, the high-density, built-up LCZs have a greater SUHI effect compared to the natural classes. Therefore, temperate climate cities will benefit from incorporating an open built-environment that has sufficient greenery and open spaces. These findings help determine the optimal urban form for temperate climates and develop heat mitigation strategies while planning, designing, or improving the new and existing urban areas. In addition, the LCZ map applied in this study for Cardiff will enable international comparison and testing of proven climate change adaptation and mitigation techniques for similar urban areas.